前交叉韧带重建术后淋巴引流手法对膝关节肿胀程度的影响  

Effect of Lymphatic Drainage Manipulation on Knee Joint Swelling after Anterior Cruciate Ligament Reconstruction

作　　者：孟聪 鲍勇 张伟明 MENG Cong;BAO Yong;ZHANG Weiming(Shanghai Ruijin Rehabilitation Hospital,Shanghai 200023,China)

机构地区：[1]上海市瑞金康复医院,上海200023

出　　处：《康复学报》2024年第1期61-68,共8页Rehabilitation Medicine

基　　金：上海市卫生健康委员会科研项目(202140221);上海市瑞金康复医院科研项目(RKYN201901)。

摘　　要：目的分析前交叉韧带(ACL)重建术后淋巴引流手法对膝关节肿胀程度的影响。方法采取前瞻性研究,选择2020年2月—2023年2月上海市瑞金康复医院康复科收治的ACL损伤患者作为研究对象,按随机数字表法分为观察组和对照组各120例。2组均行ACL重建术治疗,对照组术后采取冰敷治疗,观察组术后采取淋巴引流手法治疗。2组均连续干预4周,观察2组不同时点(术后当天、术后1周、术后2周、术后4周)膝关节肿胀度及膝关节皮肤温度;观察2组干预前后的膝关节活动范围(ROM)、膝关节功能[Lysholm膝关节评分(LKSS)]、致痛物质[P物质、5-羟色胺(5-HT)]及炎症指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]变化。结果观察组术后1、2、4周膝关节肿胀度均低于对照组(P<0.05);偏回归系数显示,术后1、2、4周时,β=-2.800、-1.760、-0.890,P均<0.001,表明术后1、2、4周时观察组患者膝关节肿胀程度均较术后当天降低;观察组*术后1周、观察组*术后2周、观察组*术后4周β=-1.070、-0.880、-0.600,P值分别为0.003、0.003、0.048,观察组*术后1周、观察组*术后2周、观察组*术后4周均较对照组降低,即观察组*术后1周、观察组*术后2周、观察组*术后4周均较术后当天降低;观察组术后1、2、4周时膝关节皮肤温度均低于对照组(P<0.05);偏回归系数显示,术后1、2、4周时,β=-0.090、-0.130、-0.520,P均<0.05,表明术后1、2、4周时观察组患者膝关节皮肤温度较术后当天降低;观察组*术后1周、观察组*术后2周、观察组*术后4周时,β=-0.193、-0.330、-0.187,P均<0.001,观察组*术后1周、观察组*术后2周、观察组*术后4周分别较对照组降低0.193、0.330、0.187℃,即观察组*术后1周、观察组*术后2周、观察组*术后4周均较术后当天降低;干预后,2组ROM、LKSS高于干预前,观察组高于对照组(P<0.05);干预后,2组P物质、5-HT均低于干预前,观察组均低于对照组(P<0.Objective To analyze the effect of lymphatic drainage manipulation on knee joint swelling after anterior cruciate ligament(ACL)reconstruction.Methods This prospective study was conducted to select patients with ACL injury admitted to the Orthopaedics Department of Shanghai Ruijin Rehabilitation Hospital from February 2020 to February 2023.The participants were divided into the observation group and control group according to the random number table method,with 120 cases in each group.ACL reconstruction was performed in both groups.Postoperatively,the control group was treated with ice compression,and the observation group was treated with lymphatic drainage manipulation.Both groups received continuous intervention for 4 weeks.The swelling degree and skin temperature of knee joint were observed at different time points(postoperative day,1 week,2 weeks and 4 weeks postoperatively).Range of motion(ROM)and knee function[Lysholm knee score scale(LKSS)]before and after intervention for both groups were observed,as well as changes in pain substances[substance P,5-hydroxytryptamine(5-HT)]and inflammatory markers[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)].Results The swelling degree of knee joint in the observation group was lower than that in the control group at 1,2 and 4 weeks postoperatively(P<0.05).The partial regression coefficient showed that at 1,2 and 4 weeks postoperativelyβ=-2.800,-1.760,-0.890 respectively,with P<0.001,indicating a reduction of knee joint swelling in the observation group at 1,2 and 4 weeks postoperatively compared to the postoperative day.The observation group*1 week postoperatively,the observation group*2 weeks postoperatively,the observation group*4 weeks postoperativelyβ=-1.070,-0.880,-0.600,P=0.003,0.003,0.048,respectively.The observation group*1 week postoperatively,the observation group*2 weeks postoperatively,the observation group*4 weeks postoperatively were lower than the control group,that is,the observation group*1 week postoperatively,the observation group*2 weeks pos

关 键 词：前交叉韧带损伤 前交叉韧带重建术 淋巴引流手法 冰敷治疗 膝关节肿胀度 

分 类 号：R687.4[医药卫生—骨科学]